For some of us, the magic of boarding an Alaskan Airlines flight from Anchorage to Atlanta with 200 other people and all their baggage, or even bigger planes aiming at crossing 12000 miles of Pacific Ocean, and finding that the thing actually lifts off the ground never fades.

Any sane thinking person should be reduced to a state of gibbering panic for the duration of the flight, but most of us put our trust in the woman at the controls and in the fact that if we don’t get there she won’t. If she had significant concerns she wouldn’t now be taking off. While aviation safety systems aren’t perfect, if the near misses or other glitches she and her colleagues report aren’t taken care of, no one gets anywhere until the problem is sorted because she won’t fly.

Riddle me this: Why take poisons?

When it comes to healing, there are lots of people who can offer you wise advice about your health and some can do a great deal of healing – people from our grandmothers through to life-style coaches, and pastors.

A wise doctor used to be someone who knew that varying rates of development were almost the definition of childhood and the best medicine was often simply reassurance, someone who rarely prescribed during pregnancy, someone who knew enough about life so that when faced with a woman apparently unhappy after childbirth would probe the state of her relationship with her husband rather than assume there was anything wrong with her hormones – but a good grandmother knew most of this.

This is the kind of wisdom we hope a good doctor might have, but none of it is unique to medicine.

What is distinct about medicine is that if you take certain problems to a doctor you are taking them to someone who has the option to poison, mutilate or shock you. The magic of medicine lies in something as counter-intuitive as getting a jumbo off the ground – in this case bringing good out of the use of a poison, or a mutilation.

If there is to be a magical moment when medicine lifts off, it used to come from the doctor at the controls but more often now comes with a doctor and patient co-pilot in the cabin – it does not come from a poison or a mutilation. Poisons are just poisons. Female Genital Mutilation is a mutilation.

Almost by definition then a good doctor has to be someone who knows when not to poison or mutilate or someone who, when things go wrong, can quickly respond with “what do you know, we gave you a poison and you’ve been poisoned, let’s see if between us we can work out where to go from here”.

But unlike a pilot, when doctors have a near miss or spot problems after giving you a poison, their views are regarded as anecdotal and are binned. Rather than support their colleagues, and refuse to use the new poison until the problems are sorted out, other doctors are liable to turn on anyone concerned about safety and accuse them of jeopardizing patient safety or medicine itself by reporting their observations.

Call me Ella

It’s common to dismiss psychiatry as the Cinder Ella specialty.

A recent past-president of the Royal College of Psychiatrists, Dinesh Bhugra, at a meeting in Hay-on-Wye in May, delivered the typical unthinking mantra when he said that psychiatry was attempting to join mainstream medicine and would get there sometime soon. We’ve been supposedly about to join the rest of medicine since the introduction of modern psychotropic drugs in the 1960s.

In fact psychiatry was the first to have specialist hospitals, and the first to have specialist journals. With Philippe Pinel in 1809 psychiatry was the first to outline the principles of evidence based medicine. Starting from the most complex clinical problems there are, Pinel was the first to show that differential diagnosis counts and other early psychiatrists followed up by distinguishing among mood disorders and psychoses in a manner that quite astonishingly stood the test of time when more specific treatments were later introduced.

The form of the randomized trial now most widely used in medicine was first used in psychiatry and psychiatry was the first branch of medicine to submit most of its treatments to controlled trials.

The talk at the moment is of Future Hospitals which will be in the community – closing the big old behemoths. Psychiatry led the way on this and on working in multidisciplinary teams forty years ago. The rest of medicine is catching up slowly.

More recently it has been the first branch of medicine to have substantial amounts of its literature ghost-written. It was the medical arena in which pharmaceutical companies first developed their abilities to sell diseases. It was the first to have professors in jail for putting non-existent patients into clinical trials. It has provided the poster-boy for medical conflicts of interest – Charlie Nemeroff.

Ticket to the ball

Psychiatry is the Sister who has got to the Ball first time after time and got her man. But this time the Prince seems completely uninterested. The options – suicide with a glass sliver or turn into an Ugly Sister?

If not one of these two options, psychiatry has to achieve another first. Its task is not, as the current President of the Royal College of Psychiatrists in Britain would have it, to get more psychiatry to people. Its task is to get to a position where people recognizing a real benefit might in a truly voluntary manner seek out psychiatric input. It has to find if there is anything about it, other than its police function, that can’t be provided by a good primary care generalist or a psychotherapist. It has to find true love.

When a surgeon makes a mistake it’s difficult to hide the consequences. A dead patient or one reduced to vegetable status. Having to meet the families of either the dead or the maimed is a reality check. While surgeons are often caricatured as arrogant, as Henry Marsh’s beautifully written Do No Harm shows failures like this temper surgical arrogance and in the best surgeons produce humility and sometimes significant anxiety.

In some but not all areas of medicine, the poisons we use come close to producing treatment induced disasters as clear cut as those facing surgeons.

There are problems when it comes to semi-disorders like osteoporosis where drug treatments may produce the fractures that the disease supposedly also produces. These do not offer the clear reality check that came with traditional medical poisoning and mutilation.

The problems with treatments that do not provide a clear reality check come to the fore in psychiatry. Depression can produce suicidality but so too can antidepressants. Psychosis can produce hallucinations but so too can antipsychotics or antidepressants. Almost all our treatments demoralize, enervate, and blunt. We simply don’t recognize these realities. This is close to psychotic. Next we’ll be thinking pumpkins are coaches.

Water into wine into antidepressant?

A good doctor can do marvelous things with treatments like the antidepressants or antipsychotics. But a doctor this good would also be able to do wonderful things with alcohol.

If alcohol were a newly discovered molecule that could be patented, it would be entirely possible to get alcohol on the market as an “antidepressant” or an “anxiolytic” putting it through the hoops that the SSRIs were forced to jump through – 6 week trials, where all we had to do was show marginal superiority compared to placebo using rating scales as outcome measures, and where we could hide the trials that didn’t work and hide the data from all trials.

Putting people, especially women of child-bearing years, who are pharma’s target market for psychotropic drugs, on alcohol chronically would be a public health disaster. But this is exactly what doctors, led by psychiatrists, have done with the SSRIs.

The State doesn’t interfere with your management of the risks of alcohol but it makes SSRIs available on prescription-only because we have every reason to think they will be more dangerous than alcohol, and yet doctors have all but been forcing these drugs on people against their patients better judgment.

Psychiatry in wonderland

Psychiatry however is a unique state of being whose inhabitants never have to say sorry.

It’s doubtful if any psychiatrist, or President of a professional body in psychiatry, has ever said sorry for more than a minute fraction of the suicides, homicides, miscarriages, or birth defects triggered by antidepressants. It’ll be a surprise if anyone owns up to the mental handicap, learning disability or autistic spectrum disorders that emerging evidence now compellingly links to treatment with antidepressants.

And if they don’t own up to clear cut things like this, what chance they will get to grips with the demotivation caused by antipsychotics, the permanent obliteration of sexual function that SSRIs can produce (Female Genital Poisoning), or the bewildering variety of problems linked to anticonvulsants?

The approval and marketing of the antidepressants is of debatable legality. The statute calls for the approval of drugs that have been demonstrated to be effective. The regulators have made it clear that the studies that were done to get these drugs on the market have shown an effect but not effectiveness. There is no evidence of lives saved or people back to work which would be most people’s idea of effectiveness. There are minor changes on rating scales completed by doctors that on a wishful thinking basis can be taken as hints that the drugs might work. But patients also completed rating scales, and their rating scales show no benefit at all – the data has been left unpublished.

The path of true love never did run smooth.

Suicide with a glass sliver

Psychiatry can, like Werner von Braun, say that’s not our department. But it’s not the regulators or even companies who strap people onto these unpiloted drones and send them on their way.

We don’t want every psychiatrist to go down with the ship and retire from practice or commit suicide if a patient commits suicide or to take into their care the patient with an autistic spectrum disorder born to a mother he has put on an antidepressant while pregnant, but we don’t want Korean ship captains either.

Banging on about the benefits of drugs like the antidepressants and refusing to acknowledge their hazards is a recipe for professional suicide. If the drugs work so well and are so free of problems, who needs psychiatrists? A good nurse could do the job more efficiently and a lot cheaper.

If the magic lies in the drug, who needs magicians?

The ugly sister

It may be the reason psychiatry hasn’t managed professional suicide just yet is because of its growing police function. As part of an increasing turn to risk management in healthcare, an ever greater number of patients are being legally detained, and put on community treatment orders, or illegally detained under a variety of Protection of Vulnerable Adult or related maneuvers.

Back in the 1970s or 80s when most of the current leaders of the profession entered the field, it was on the back of a promise that, while we might have to lock up some people temporarily in their own interests, broadly speaking our role was about facilitating growth and supporting people in their efforts to secure freedom from oppression. Few if any people entering the field could think this now.

Back in the 70s, we were concerned that legitimate protest was being sedated in the suburbs with benzodiazepines. Now the message to women with issues is to take SSRIs to empower yourselves and stop disturbing us.

Psychiatry has been a master of reinvention – like Moriarty in the Sherlock Holmes stories. To a much greater extent than it has realized, it has led in both good and bad developments in medicine. But do we really want to lead medicine down this path?

What instincts might lead someone into a profession whose mission is to control behavior and who doesn’t recognize a poison as a poison?

You’d be surprised:

“He who would do a great evil must first persuade himself he is doing a great good.”

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Comments

Hi David,
I guess one of the most important faults of the psychiatric system is the psychiatric education.
First the psychiatrists learn to be physicians and there’s a lot of biochemistry in this education. They learn about molecules and how to work with them. Than they arrive at psychiatry – and the situation is still like 19th century.
The biochemistry of psychiatric deseases is still unknown.
So what should they do?
Try to talk to the patients and help them solving their problems? That was not in their education.
That would be something completely new.
– And the education has ended (!)
So most of them decide to stay with the molecules and biochemical theories. Allthough they might know, it is wrong (it does not help the patients) but that was what they learned.

So maybe at first they are a bit unsure, but than they realize there is a very nice, clean looking industry with lectures in nice hotel rooms … and these people are talking about biochemistry. They say: Don’t forget about it. It works! Tell us, what you think about it. We will pay for your lecture.

Thanks for this. Except biology is a source of variation and likely the determinant of true love. The thing that concerns me about psychiatric education at the moment is the standardization and techniques of control that all come from the social sciences – not biology.

These days psychiatrists’ explanations of their work seem to owe more to Madison Avenue than to science of any sort. Take what is now called the “serotonin story” of depression. While most, if pressed, will admit it’s baseless (or at least that “things are more complicated than that”), they still defend it as a useful tool for helping patients (mis) understand their illness and need for meds. They seem genuinely bewildered when the patients, on learning the real state of the science, use harsh words such as “I’ve been lied to!”

Lacking anything more solid, I think most docs start to believe the stories themselves. “You must take the antidepressant with a mood stabilizer; that way it will never stop working,” they tell us. How? Why? Damn if they know; maybe it’s based on the story of the Wise Man Who Built His House Upon a Rock, which we all learned in Sunday School. Swallow the big pill, and it will stabilize the little one. Like a rock.

“Why don’t you just think of these awful spells of depression you have as seizures,” one doc advised me, trying to get past my reluctance to take the latest Mood Stabilizer. Never mind that this year’s favorite potion, unlike last year’s, was not even an anti-convulsant. (As a matter of fact, this one lowers the seizure threshold.) I was tempted to tell him I had a better idea: Why don’t I think of them as tumors? Then I can hire someone to cut them out! And to think that some of these people are the first to rant and rave about the public’s lack of understanding and respect for Science …

There are a number of videos available on the topic of psychotropic drugs and children. One of the outstanding things, to me, on watching these, aside from a reaction of horror, is the complete failure of the psychiatrists to recognize genetic disorders such as FragileX, Noonan syndrome, William syndrome etc. none of which can be treated by drugs. The worst is failure to see evidence of abuse especially in girls. Are these and similar conditions omitted from psychiatric training?

Let’s not forget the biology that mimics psychiatric disorders. How many psychiatrists remember that a full physical examination comes first? How many would recognize a myxedematous depression and refer to an endocrinologist? how many can identify hearing loss as a mimic of dementia?

I think that across the whole spectrum of medicine the thing that has gone wrong is lack of care and common sense.

Everything is about giving the patient a label and popping them in a pigeon hole. Who cares if they don’t fit just manipulate things so they do and then Hey Presto the patient is diagnosed, given a repeat prescription… JOB DONE.

Diagnosis now for many Doctors and patients is not a joint process. It’s not about the Doctor listening to the patient. It’s about stats, ticking boxes and if nothing fits make it fit. Then give a pill.

I had the misfortune a few years ago to be in the care of a very arrogant GP. He was getting rather frustrated by the fact that I had been having symptoms that he couldn’t diagnose for a few months. He had done some bog standard bloods and tests but couldn’t find anything. So he decided that I must be depressed and offered me antidepressants…. when I refused because I knew I wasn’t depressed he told me in a very nice way that if I came back to see him again he would have no choice but to diagnose Chronic Fatigue Syndrome. I told him apart from tiredness none of my symptoms fit CFS, he said and I quote ” well that’s the only thing I have left”.
Needless to say I changed GP and subsequently found out I had thyroid disease.

I don’t want to seem as if I’m slagging Doctors off. There are some amazing Doctors out there, ones who genuinely care. They don’t have enough time to spend with patients and also we the general public are more demanding in that we want answers and solutions for our woes and we want them quick.

I don’t know what the answer is but I think it lies in the fact that Doctors aren’t in charge of medicine any longer. Pharmaceutical companies, Managers, Stats and box ticking rule the medical world.

Fantastic article. Totally resonates with my experience.
There is also the trauma created by the doctor which creates fear in his/her patient.
This causes the black cloud to come in and take hold of the patient- if caught off guard.
This fear/trauma is then used to get the patient to sign for the treatment the doctor or specialist recommends.
A patient may suggest going the old natural route and will be shot down in a heartbeat.
But if the patient is wise enough to know about trauma methods – breaking down the patient- and asks calmly ” so can you tell me that this surgery, meds etc is a cure? their heads drop and they admit. Then you can walk out of the office in peace.
I found the keeping of the patient in the office until s/he broke down was abuse and most likely against the law.
On our writing course , I heard a GP express all this too and she was appalled at her own treatment.
Oh and forgot to mention Russia and its training of doctors etc – so different.
How many psychiatrists and doctors treat their patients as living whole human beings and include their soul?
I have yet to meet one who can do soul journeys and bring back the wounded part and heal the patient together – as its a joint journey.
Oh YES to doctors not spotting abuse before and after pregnancy and patients actually believe the doctor is trained to spot it and ask questions.
Worse again is the doctor who claims to be an expert in suicide etc who supports male abusers – such a shock for the vulnerable mother and children.
As you say, these doctors never have the balls to say sorry, but carry on and then we read of another patient destroyed in the same way.
Also this family law training of judges etc to see all mothers as feeble minded/mentally ill because they have wombs etc- hysteria, drives me to write and write as few people know this. The female victim of abuse will be sent to psychiatrist but the perpetrator rarely……so the old conditioning lives on.
Thank you for writing truth as you do.
I look forward to each article now.

Very entertaining blog post David which hits home with fairy tale precision. Thanks for writing it.

I laughed through most of it in sheer enjoyment as you exposed one truth after another with scarcely time to take a breath. It is more sharp and biting because you are a doctor, a drug prescriber, a writer, a scientist, a risk taker and a mad man. Plus many other strengths and weaknesses, no doubt, because they are linked, in each of us. Both sides of the same coin.

As the co pilot who had a twenty year relationship with an international airline pilot, how many people are aware that the Captain has one or more second in command officers and one or more flight engineers on board as well as highly trained stewards and hostesses who all ensure that you will arrive at your destination…..

It’s all very well getting on to your Virgin Aeroplane for your holiday or your shopping trip or your freeby from a pharmaceutical company – in place, is the most regulated, most safe way to travel.

The virgin patient might expect the same level of airline courtesy.

Welcome on board, this flight to….there might be turbulence, but, this is the Captain Speaking…enjoy the ride
We anticipate arrival behind schedule due to headwinds
Follow the tracker on the headrest and we will keep you informed all the way.
Speed; Height; Location

It would be an end to the airline business if the Civil Aviation Authority (MHRA) did not fit a black box into the aeroplane. This essential black box will contain all errors when an aeroplane plunges into the South China Sea.

All aviation disasters are rigorously and robustly investigated.

If a Captain has an off day, it is not really a problem. He has his team and he has his auto-pilot, so pilot error is very rare.

What do they teach trainee psychiatrists at flying school?

Psychiatrists delving into sophisticated engines seem to mix up their hydraulics with their spontaneous combustion with their altruism….do they know what they are doing, and, if, not, why, not?

Does a trainee psychiatrist wake up one morning and choose his vocation because it is interesting, mentally stimulating and helpful to society?

Annie makes an important point. It was only after posting that I realized its not just about doctors and patients – that all sorts of others have an important part to play in the poisoning for good or bad.

This is a clip from the highlights from Airplane -which ends with a “nurse” and “patient” landing the plane. The most stereotyped figure in the whole ensemble is the doctor – worth watching just for him.

And when the autopilot gives conflicting data, any pilot can become dumbfunded, because it’s hard for the pilot to switch back to all manual piloting.
Many times a pilot might have troubles finding references as horizon to know what side is up. Or asess his airspeed if the pitot-tube malfunctions.

But there are documents and manuals in Place for pilots to turn to when flying becomes out of the ordinary.
The pilot has co-pilot and often an engineer to turn to, even radio for help.

And yes, the NTSB has often come across modern pilots who are too dependant on technology to guide them, they raise concern about the skill of the pilots being lost behind the aid of complex autopilots.

In medicine, I falsely thought the same fail-safe methods was used.
That if the antidepressants do not shorten the time the patient is ill, (my case, 15 years plus on AD’s) or the onset of new diagnoses originally not to be found in the patient, could infact be caused by the drug.

That your doctor could switch to ‘manual doctoring’, and recognize that the drugs might cause the new diagnoses.
But the doctors seem unwilling to step away from the ‘autopilot’, they base all the ‘failed’ patients on the same grounds as those that apparently benefit from their care.

We who develop new diagnoses and sustain prolonged illness becomes the ‘airplanecrashes’ that no one investigates, and thus no one will ever be able to prevent further crashes.

We need a truly neutral Commission like the “NTSB” to oversee doctor behaviour and drug effects.
//Ove

Just to say – how pleased I am the ‘doctor’ resurfaced as for us it was a brilliant piece of parody and I am glad you took the time to think about it. It’s not often you can find the perfect ‘doctor’ sketch.
‘Doors to Manual’.
Thanks.
Annie:)

No one has talked about the new airline called “Forced Airline”. While they do offer on board movies and some meals, it is my understanding that it is somewhat difficult to get off the flight once you’re on board. I’ve also heard that the flights encounter more and more turbulence as time progresses.

As there is only one pilot and as his education was highly subsidized by PharmCo, we’re heard concerns that he might have difficulty getting his (her) “passengers” to their desired destination.

I have nothing poetic or profound to say, except that after 30+ years of the Antidepressants, and after multiple bad reactions to various SSRI/SNRI types, I was finally re-diagnosed as Bipolar, as opposed to my long term diagnosis of Major Depression, Severe, and Recurrent. Finally, after allowing me to take the lowest dose Duloxetine – 25mg, for musculo-skeletal pain, effective incidentally, I was diagnosed with SIADH, essentially, that is to say, Low Sodium levels. After going off, Sodium levels fluctuated a little, but was kept on lowest dose Mirtazipine, 7.5mg, 1/2 the lowest dose, which I had been taking for sleep. Had not had a Bipolar event in about 6 years. However, was pulled off even that low dose, as went full blown Mania a couple months ago. No further low, or fluctuating Sodium, a potentially lethal condition. It seems the role of Typical Antidepressants in a long term Depressive, as well as the role of SIADH in older women is only now coming to light. So, you might say I was poisoned by these drugs. Not to mention that now just coming to recognition is the correlation of Benzodiazepines in early onset Dementia. If so, I am essentially screwed, and truly poisoned, by my long association with these “medications” “First do no harm?”

Just possibly at the root of it is the self-delusion of politicians and their need to have people engage in magical thinking on their behalf, so they become hosts to every kind of mountebank and liar – not only the tailors who make the invisible suit, but all the courtiers who maintain the fantasy that the politicians are truly remarkable people who make it all happen. I suppose the pharmaceutical companies are the tailors. The courtiers are the courtiers. Ben Goldacre introducing RCTs to the Cabinet Office?

Is it me, or, why does a doctor feel he is a collective voice for those drowning under a sea of medication and under siege from hypocritical doctors who step back, and, say
“who, me?”

Is this ‘token’ doctor going to be wheeled out every time there is a bit of chat about the overwhelmingly disgusting nature of force-fed medication which a patient has absolutely no way of discovering whether it is safe, unsafe, wise or sensible to swallow.

Alltrials chose GlaxoSmithKline as their nemesis for self-promoting videos about Clinical Trials and made an International Statement that GlaxoSmithKline were transparent about Clinical Trials.

Whether they are, or whether, they are not, GlaxoSmithKline sell Paroxetine, which features on Rxisk.org, and, it seems that once again television interviewers are kept in the dark, do not ask the right questions and fail to bring into the spotlight one single patient who might discuss the dark side…….

A series of articles in Medscape last year on physician job stress had some sobering news about US psychiatrists, at least. They ranked as one of the least stressed-out specialties, on a par with the ophthalmologists. Only pathologists had lower burnout rates. Why? First of all, greater control over their schedules. In other words, no one calls these people to the scene of an emergency. Residents and nurses in the ER, social workers, and increasingly, cops, handle the patient in crisis. The treating shrink gets a phone call at most.

They’re also less subject to the stress of wrangling with insurance – because so many don’t take it. “Many psychiatrists won’t take Medicare or Medicaid because the fees are so low,” explained APA president Jeffery Lieberman. They also may not accept private insurance if the fee schedule is chintzy, and well-insured patients may choose to pay out of pocket if they can, so the boss and the insurance company don’t find out about their diagnosis. About 40 – 50% of U.S. psychiatrists now see self-paying patients only.

This means, of course, that they rarely see the working class, and don’t see poor folks at all. It also means they rarely see patients whose problems are serious enough to put them on disability. For years a single enterprising Chicago shrink, Dr. Michael Reinstein, “treated” over 4,000 Medicare and Medicaid patients in nursing homes, mainly folks with schizophrenia. Everyone knew the situation was dreadful – but no one called him out, because no one wanted his patients.

What stressors do they have? According to Medscape, they’re more likely than other docs to feel “clinically handcuffed” – unable to give patients the care they need. Despite the official line, most shrinks know deep down that “med mgt” is at best inadequate treatment, and at worst downright useless or harmful. Some of the older ones, extensively trained in psychotherapy, give this as their excuse for adopting a cash-only model: it frees them to do the odd bit of psychotherapy when needed, even if only with the privileged. The younger generation sees only a future of endless ten-minute med-checks.

Well… if you aren’t clever with your hands, but you don’t have the people skills to be a GP either, it may be a good fit. As long as those clinical handcuffs don’t chafe. Maybe it’s not professional suicide, so much as professional extinction.

To continue the airplane analogy, especially with respect to “old” drugs that have fallen out of favour, the safest plane is probably something like the Cessna Skyhawk. Light, minimum controls and only one engine. If that fails, it can glide for up to seven miles and land on a road, a pasture or just about any smooth surface. Mishaps are almost always due to pilot error. No need for fancy anything and using instrumentation and aerodynamics little changed since the Wright brothers. We seem to have allowed really good medications for appropriate patients, such as the MAOIs to all but disappear in the seduction of “newer and better” proposed by Big Pharma leading to “pilot error” that damages only the passenger.

If an aeroplane crashes it is a problem for the industry, although they may like to pass it of as pilot error or malice. If a citizen crashes because of a drug or a vaccine the connection can generally be successfully denied, dismissed as mere coincidence. At least, with the aeroplane you know the immediate reason why people have died is because it has crashed.

Airliner disasters are relatively infrequent these days although they tend to be a bit mysterious when they happen. But the awful tale of the RAF Chinook in 1994 tells you a lot about the ruthlessness of government departments:

The issue ultimately is the potential for deniability by the corporate or government machine. Unfortunately we know that with pharmaceuticals it is very easy indeed. There is huge pressure on aeroplane manufacturers to make sure their products are safe and mostly they are these days. With pharmaceuticals the corporations and the government agencies can just deny everything, and it is by far the easiest option. If they can behave badly why will they behave well? Nothing in the history of humanity tells us they will.

The list of *firsts* that bear the signature of psychiatry is longer and more nefarious than this:

>>The form of the randomized trial now most widely used in medicine was first used in psychiatry and psychiatry was the first branch of medicine to submit most of its treatments to controlled trials. The talk at the moment is of Future Hospitals which will be in the community – closing the big old behemoths. Psychiatry led the way on this and on working in multidisciplinary teams forty years ago. The rest of medicine is catching up slowly. More recently it has been the first branch of medicine to have substantial amounts of its literature ghost-written. It was the medical arena in which pharmaceutical companies first developed their abilities to sell diseases. It was the first to have professors in jail for putting non-existent patients into clinical trials. It has provided the poster-boy for medical conflicts of interest – Charlie Nemeroff. >>

More recently, psychiatry has launched a hostile take over of complex medical cases, mostly children with so-called *rare diseases*. Psychiatrists determine which of the medical/surgical treatments a *child* has received that were, a) unneeded, and b) initiated by a parent(s). A psychiatrist, thus determines that the child is a victim of “Medical Child Abuse”.

WHO granted psychiatrists this authority? Well, let’s see– the pediatric specialist who actually confers the diagnosis is a “Pediatric Child Abuse” (board certified) expert– previously engaged in investigating mandated reporter’s suspicions regarding physical injuries or disclosures by children that they had been abused/neglected or molested, NOW, same child abuse experts are acting on the suspicions of other doctors, mainly psychiatrists, who are as inept as the Pedi Child Abuse expert . him/herself on matters of *medically complex cases involving rare diseases*. Blind leading the blind, comes to mind- as none of these doctors has the clinical background to warrant their assuming to be authorities on the medical treatment rendered by actual pediatric medical specialists.- Or maybe a more appropriate analogous cliche would be, smoke and mirrors.

Here is the explanation that an 8 year old can grasp:

A psychiatrist renders a *medical* opinion that is based on inferring that IF a child has a diagnosis of a disorder that cannot be substantiated by irrefutable, objective clinical test results, the disorder can be negated entirely or categorized as *symptoms* of a psychiatric disorder– that similarly cannot be substantiated by irrefutable, objective clinical test results. The psychiatric diagnosis trumps the medical diagnosis by virtue of its being supported by a pediatric child abuse expert, who can diagnose “Medical Child Abuse”– and accomplish two things:

1) The parent(s) will submit to the psychiatric diagnosis.
2) The child’s pediatric medical specialists will be banned from treating the child-

My 8 year old grand son called this: “crazy”– after asking several perfectly logical questions.

So– psychiatrists flew this new diagnosis past the American Academy of Pediatrics in the U.S., who failed to see the glitch in having an unqualified *expert* making a diagnosis based upon the opinions of medically unqualified psychiatrists. Smoke and mirrors- or just plain crazy?

NEXT– The American Psychiatric Society rubber stamped *Somatic Symptoms Disorder* for inclusion in their new Bible, DSM V. SSD grants psychiatrists the authority to determine what are the reasonable responses of a patient suffering from a*medically complex/rare disease*– or at what point can this new psychiatric diagnosis, SSD, be considered the primary focus of treatment.

I offer this update on firsts by psychiatry to address Dr. Healy’s question :

>>What instincts might lead someone into a profession whose mission is to control behavior and who doesn’t recognize a poison as a poison? >>

Predatory instincts are as clearly evident here, as remnants of a profession have virtually disappeared– , which is to say that psychiatry has morphed itself into a criminal element — so–

We can dispense with the time consuming, tedious, expensive medical malpractice law suits and proceed directly to criminal arrests. I propose heavy fines to augment lengthy prison sentences–and strict conditions for parole: additional financial restitution and community service IF both written and verbal apologies are made public.

Similar psychiatric disasters to those related to anti-depressants may be caused by hormonal contraceptive drugs and HRT in susceptible women — and the 2 drugs can combine to produce more serious effects than either would have done alone. Yet, if anti-depressants are only occasionally recognised as causing these problems, hormonal drugs are never recognised as doing so. This is in spite of a 2014 follow-up to the Nurses Health Study which stated in its conclusion that ‘Oral contraceptive use was associated with certain causes of death, including increased rates of violent or accidental death’. (British Medical Journal 2014 Oct 31; 349:g6356)